Gabriele Saccone1,2, Andrea Ciardulli3, Serena Xodo4, Lorraine Dugoff5, Jack Ludmir6, Francesco D'Antonio2,7, Simona Boito2,8, Elena Olearo2,9, Carmela Votino2,10, Giuseppe Maria Maruotti1,2, Giuseppe Rizzo2,11, Pasquale Martinelli1,2, Vincenzo Berghella12. 1. a Department of Neuroscience, Reproductive Sciences and Dentistry , School of Medicine, University of Naples Federico II , Naples , Italy. 2. b Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG). 3. c Department of Obstetrics and Gynecology , Catholic University of Sacred Heart , Rome , Italy. 4. d Department of Gynaecology and Obstetrics , School of Medicine, University of Udine , Udine , Italy. 5. e Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Reproductive Genetics , Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA USA. 6. f Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine , Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA. 7. g Fetal Medicine and Cardiology Unit, Department of Obstetrics and Gynecology , University Hospital of Northern Norway. Perinatology Research group , Department of Clinical Medicine , University of Tromso , Norway. 8. h Department of Obstetrics and Gynecology , L. Mangiagalli Fondazione IRCCS Ca'Granada, Ospedale Maggiore Policlinico , Milan , Italy. 9. i Department of Surgical Sciences , University of Turin , Turin , Italy. 10. j Department of Experimental and Clinical Medicine, Division of Obstetrics and Gynaecology , Magna Graecia University of Catanzaro , Catanzaro , Italy. 11. k Department of Obstetrics and Gynecology , Università Roma Tor Vergata , Rome , Italy. 12. l Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA.
Abstract
OBJECTIVE: To evaluate the effectiveness of cervical pessary for preventing spontaneous preterm birth (SPTB) in twin pregnancies with an asymptomatic transvaginal ultrasound cervical length (TVU CL) in the second trimester. METHODS: We performed a meta-analysis including all randomized clinical trials (RCTs) comparing the use of cervical pessary (i.e. intervention group) with expectant management (i.e. control group). The primary outcome was incidence of SPTB <34 weeks. RESULTS: Three trials, including 481 twin pregnancies with short cervix, were analyzed. Two RCTs defined short cervix as TVU CL ≤25 mm and one as TVU CL ≤38 mm. Pessary was not associated with prevention of SPTB, and the mean gestational age at delivery and the mean latency were similar in the pessary group compared to the control group. Moreover, no benefits were noticed in neonatal outcomes. CONCLUSIONS: Use of the Arabin pessary in twin pregnancies with short TVU CL at 16-24 weeks does not prevent SPTB or improve perinatal outcome.
OBJECTIVE: To evaluate the effectiveness of cervical pessary for preventing spontaneous preterm birth (SPTB) in twin pregnancies with an asymptomatic transvaginal ultrasound cervical length (TVU CL) in the second trimester. METHODS: We performed a meta-analysis including all randomized clinical trials (RCTs) comparing the use of cervical pessary (i.e. intervention group) with expectant management (i.e. control group). The primary outcome was incidence of SPTB <34 weeks. RESULTS: Three trials, including 481 twin pregnancies with short cervix, were analyzed. Two RCTs defined short cervix as TVU CL ≤25 mm and one as TVU CL ≤38 mm. Pessary was not associated with prevention of SPTB, and the mean gestational age at delivery and the mean latency were similar in the pessary group compared to the control group. Moreover, no benefits were noticed in neonatal outcomes. CONCLUSIONS: Use of the Arabin pessary in twin pregnancies with short TVU CL at 16-24 weeks does not prevent SPTB or improve perinatal outcome.
Authors: Noor E Simons; Cornelieke van de Beek; Johanna H van der Lee; Brent C Opmeer; Aleid G van Wassenaer-Leemhuis; Anneloes L van Baar; Leonie Steenis; Sophie Liem; Ewoud Schuit; Dick Bekedam; Ben W J Mol; Janneke Van't Hooft Journal: Acta Obstet Gynecol Scand Date: 2019-06-18 Impact factor: 3.636